Predictors for Neoplastic Progression in Patients With Barrett's Esophagus: A Prospective Cohort Study

Sikkema, Marjolein; Looman, Caspar W.N.; Steyerberg, Ewout W.; Kerkhof, Marjon; Kastelein, Florine; Dekken, H. van; Vuuren, Adriana J. van; Bode, W. A.; Valk, Hans van der; Ouwendijk, Rob J.; Giard, R. W. M.; Lesterhuis, Wilco; Heinhuis, R.; Klinkenberg, E. C.; Meijer, Gerrit A.; Borg, Frank ter; Arends, J.; Kolkman, J. J.; Baarlen, Joop van; Vries, Richard A. de; Mulder, A. H.; Tilburg, Antonie J.P. van; Offerhaus, G.J.A.; Kate, Fiebo J.W. ten; Kusters, Johannes G.; Kuipers, Ernst J.; Siersema, Peter D.

doi:10.1038/ajg.2011.153

Cited by 160 publications

(136 citation statements)

References 43 publications

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“…In a retrospective study using the CORI (Clinical Outcomes Research Initiative) database, the yield of BE in white men with GERD was 2% in the third decade of life, but increased to 9% in the sixth decade ( 4 ). Early age ( 198 ) LGD to EAC 24 Studies, 2,694 patients 5.4/1,000 person-years 3-8…”

Section: Summary Of Evidencementioning

confidence: 99%

“…Given the low rate of progression in these patients, the low but real rate of complications of endoscopic therapy ( 149 ), and the costs associated with its delivery ( 150 ), ablative therapy cannot be recommended in patients with nondysplastic BE. Whether these therapies are warranted in subjects judged to have a higher lifetime risk of cancer, such as those with familial BE/EAC and young patients with long segments of BE, is unclear (151)(152)(153).…”

Section: Summary Of Evidencementioning

confidence: 99%

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ACG Clinical Guideline: Diagnosis and Management of Barrett’s Esophagus

Shaheen

Falk

Iyer

et al. 2016

American Journal of Gastroenterology

1,335

1,412

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Recent population studies suggest that gastroesophageal refl ux disease (GERD) is increasing in prevalence, both in the United States and worldwide ( 1,2 ). Th e diagnosis of GERD is associated with a 10-15% risk of Barrett's esophagus (BE), a change of the normal squamous epithelium of the distal esophagus to a columnar-lined intestinal metaplasia (IM). Risk factors associated with the development of BE include long-standing GERD, male gender, central obesity ( 3 ), and age over 50 years ( 4,5 ). Th e goal of a screening and surveillance program for BE is to identify individuals at risk for progression to esophageal adenocarcinoma (EAC), a malignancy that has been increasing in incidence since the 1970s ( 6,7 ).Th e purpose of this guideline is to review the defi nition and epidemiology of BE, available screening modalities for BE detection, rationale and methods for surveillance, and available treatment modalities including medical, endoscopic, and surgical techniques. In order to evaluate the level of evidence and strength of recommendations, we used the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system ( 8 ). Th e level of evidence ranged from "high" (implying that further research was unlikely to change the authors' confi dence in the estimate of the eff ect) to "moderate" (further research would be likely to have an impact on the confi dence in the estimate of eff ect) to "low" (further research would be expected to have an important impact on the confi dence in the estimate of the eff ect and would be likely to change the estimate) or "very low" (any estimate of eff ect is very uncertain). Th e strength of a recommendation was graded as "strong" when the desirable eff ects of an intervention clearly outweighed the undesirable eff ects and as "conditional" when there was uncertainty about the tradeoff s. We used meta-analyses or systematic reviews when available, followed by clinical trials and cohort and case-control studies. In order to determine the level Barrett's esophagus (BE) is among the most common conditions encountered by the gastroenterologist. In this document, the American College of Gastroenterology updates its guidance for the best practices in caring for these patients. These guidelines continue to endorse screening of high-risk patients for BE; however, routine screening is limited to men with refl ux symptoms and multiple other risk factors. Acknowledging recent data on the low risk of malignant progression in patients with nondysplastic BE, endoscopic surveillance intervals are attenuated in this population; patients with nondysplastic BE should undergo endoscopic surveillance no more frequently than every 3-5 years. Neither routine use of biomarker panels nor advanced endoscopic imaging techniques (beyond high-defi nition endoscopy) is recommended at this time. Endoscopic ablative therapy is recommended for patients with BE and high-grade dysplasia, as well as T1a esophageal adenocarcinoma. Based on recent level 1 evidence, endoscopic ablative therapy is ...

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Section: Summary Of Evidencementioning

confidence: 99%

Section: Summary Of Evidencementioning

confidence: 99%

ACG Clinical Guideline: Diagnosis and Management of Barrett’s Esophagus

Shaheen

Falk

Iyer

et al. 2016

American Journal of Gastroenterology

1,335

1,412

View full text Add to dashboard Cite

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“…In the studies performed on patients with GERD or any gastrointestinal system complaint in the countries to the west of Turkey, the prevalence of ERD varied from 10.2% to 50% (45,46). Moreover, in a study on patients having only dyspepsia in Brazil, the rate of ERD was found to be as low as 8.6% (47).…”

Section: The Epidemiology Of Gerd Complications In Turkey and Around mentioning

confidence: 99%

“…On the other hand, in a study conducted in Japan, the rate of patients that were endoscopically diagnosed with BE was reported to be 37.6%. However, a problem in this study arises from the fact that the authors defined the esophagogastric junction as the area where the esophageal palisade vessels ended (44).In the studies performed on patients with GERD or any gastrointestinal system complaint in the countries to the west of Turkey, the prevalence of ERD varied from 10.2% to 50% (45,46). Moreover, in a study on patients having only dyspepsia in Brazil, the rate of ERD was found to be as low as 8.6% (47).…”

mentioning

confidence: 99%

How is the gastroesophageal reflux disease prevalence, incidence, and frequency of complications (stricture/esophagitis/Barrett’s esophagus/ carcinoma) in Turkey compared to other geographical regions globally?

Bor

Yüksel

2017

Turk J Gastroenterol

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Although many studies are conducted on gastroesophageal reflux disease (GERD) and its complications, the questionnaires and reflux definitions used in the studies are different. Mayo, GERD-Q, DIGEST-Q, RDQ, and various other questionnaires that were created and have been used in the studies. The GERD definition that is mostly accepted around the world is the presence of the complaints of heartburn and/or regurgitation at least once a week. However, many different definitions, such as the presence of heartburn and/or regurgitation at least twice a week or at least once a year (if once a week, "frequent"; if once a year, "rare") and the presence of heartburn and/or regurgitation without considering the frequency and severity, were all used in the studies. Therefore, it is quite difficult to obtain a single datum by collecting these studies. However, studies including all questionnaires and reflux definitions were considered while collecting this data.Another problem encountered while performing epidemiological scanning of GERD is that when the world was separated into two parts as the East and the West, some countries that were different from each other were included in the same group (such as Iran-China and Germany-Brazil). Even though continents are considered for this separation, countries that do not resemble each other from any perspective, such as Iran and China, were included in the same group. Therefore, groups must be formed according to the higher number of ethnic distributions. There are also regional epidemiological differences even in the same country. Moreover, there is no term equivalent to heartburn and regurgitation in some Eastern languages.Turkey is geographically located in the middle of the Eastern and Western countries and the epidemiology of GERD and its complications is similar to both geographical groups (Figure 1). In the Eastern countries, the prevalence of GERD is lower and regurgitation is predominant. On the other hand, in the Western countries, the prevalence of GERD is higher and heartburn is predominant. Considering the complications, erosive esophagitis, Barrett's esophagus, and associated esophageal adenocarcinoma are seen in the Western countries more commonly.In GERD epidemiological studies performed in Turkey, the Mayo questionnaire was mostly used (1, 2). The GERD-Q form was used in one study (3). The studies in which the Mayo questionnaire was used, found the prevalence of GERD as 20% (1), 19.3% (2), 12.5% (4), and 22.8% (5,6), respectively. In the study using the other question form, the prevalence of GERD was 24.7% (3). When 5 studies were evaluated cumulatively, the prevalence was calculated to be 23%. It was observed that regurgitation was predominant in all of the studies. In the cumulative evaluation, the rate of prevalence was 23% for regurgitation and 19% for heartburn.While the date of the publications on the epidemiology of GERD goes back to the 2000s in the countries to the east of Turkey, the first articles on this subject were written in 1990s in the Western cou...

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“…For this reason, it is essential that further risk stratification strategies will be developed to identify the subgroup of LGD patients who will benefit from ablative treatment in order to reduce unnecessary adverse events and costs in patients without a risk of neoplastic progression. It can be expected that the inclusion of additional risk factors for developing highgrade dysplasia and adenocarcinoma in BE, e.g., a known duration of BE of C10 years, longer length of BE, and presence of esophagitis [5], may help in risk stratification. Furthermore, it is recommended to ablate LGD only after revision by an expert pathologist and with two consecutive endoscopies confirming a diagnosis of LGD.…”

mentioning

confidence: 99%

Endoscopic Treatment for Dysplastic Barrett’s Esophagus

Kestens

Siersema

2014

World j. surg.

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We read the article by Subramanian et al. [1] with great interest. The authors provided a concise but complete overview of the current state of endoscopic treatment modalities for nondysplastic and dysplastic Barrett's esophagus (BE). They concluded that visible lesions in BE should be treated with endoscopic resection, either endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD), and with radiofrequency ablation (RFA) of residual intestinal metaplasia. We would like to make some additional comments in regard to the treatment of patients with dysplastic BE.As mentioned in the article, current guidelines recommend endoscopic treatment, i.e., ablation, as an option for patients with low-grade dysplasia (LGD) in BE. However, before considering endoscopic treatment for a patient with LGD, it is important that the diagnosis of LGD is confirmed by an expert pathologist. It is known that histological evaluation of BE is associated with a high interobserver variability, especially in cases of LGD. Various studies have shown that a relatively high number of LGD cases are downstaged to nondysplastic BE after revision [2]. Furthermore, even after revision by an expert pathologist, the SURF trial reported that more than 27 % of BE patients with LGD were found to have no dysplasia during follow-up [3]. This high number of patients with no dysplasia during follow-up likely can be explained by an incorrect initial diagnosis and consequently these patients probably had a much lower risk of neoplastic progression.It is also important to emphasize that ablative treatments are not without complications, e.g., stricture formation after RFA has been reported in 7-12 % of cases [3,4]. For this reason, it is essential that further risk stratification strategies will be developed to identify the subgroup of LGD patients who will benefit from ablative treatment in order to reduce unnecessary adverse events and costs in patients without a risk of neoplastic progression. It can be expected that the inclusion of additional risk factors for developing highgrade dysplasia and adenocarcinoma in BE, e.g., a known duration of BE of C10 years, longer length of BE, and presence of esophagitis [5], may help in risk stratification. Furthermore, it is recommended to ablate LGD only after revision by an expert pathologist and with two consecutive endoscopies confirming a diagnosis of LGD.When it is decided that a segment of Barrett's esophagus should be ablated, it is advisable that patients are referred to a center with ample experience in ablative techniques in order to improve treatment outcomes. A recent study showed that the rate of complete eradication of intestinal metaplasia after RFA increases when performed by an experienced endoscopist [6].EMR, ESD, and RFA are all newly developed techniques and therefore long-term follow-up data are limited. Conclusions regarding the (cost-)effectiveness and recommendations on the optimal treatment strategy of different types of patients are preliminary. Furthermore, complete eradic...

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Predictors for Neoplastic Progression in Patients With Barrett's Esophagus: A Prospective Cohort Study

Cited by 160 publications

References 43 publications

ACG Clinical Guideline: Diagnosis and Management of Barrett’s Esophagus

ACG Clinical Guideline: Diagnosis and Management of Barrett’s Esophagus

How is the gastroesophageal reflux disease prevalence, incidence, and frequency of complications (stricture/esophagitis/Barrett’s esophagus/ carcinoma) in Turkey compared to other geographical regions globally?

Endoscopic Treatment for Dysplastic Barrett’s Esophagus

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